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Houses in north London. Photo: Andrew Parsons/PA Images. All rights reserved.Afghan immigrant women in London seem to be suffering from a slow and hidden epidemic of unwanted pregnancies. The government has failed to give an exact picture of what is happening on the ground. However, at South Asian Sexual Health (SASH) we have conducted research that suggests a lack of awareness about sexual health is endemic among first generation immigrant families.

We interviewed more than 40 Afghans (women and men) in four boroughs of west and north-east London. Their testimonies reflected how racism and sexism have combined to produce numerous unintended pregnancies. Women are being denied basic human rights by male members of their families and the British government must do more to help them and address the sexual health burden they carry.

‘Shockingly, moving to Britain seems to have done little to help Afghan women transform their lives’

Shockingly, moving to Britain seems to have done little to help Afghan women transform their lives. Twelve of the 20 women we interviewed were married, and most of these married women were unemployed – but not because of a lack of qualifications. Most were university graduates, including doctors. But they weren’t “allowed to go outside,” as several respondents put it.

Recruiting Afghan women to participate in research like this is extremely difficult as they often live in secluded communities that are hard for researchers to reach, in part because of language issues. Our in-depth discussions – in Dari and Pashtu – were intimate and emotional.

Rabia*, 41 and a mother of four, was a medical doctor in Afghanistan. She moved to London 17 years ago to live with her husband. She expressed little or no control over her sexuality. Rather, her testimony reflected how her body is bound by cultural assumptions that women’s duty is to submit to men’s demands. She said, for example, that she “never wanted to wear Hijab” but that her “husband gets upset” when she doesn’t.

“I'm not allowed to go out without my husband’s permission”

Nasrin*, 32, had an arranged married with a 43 year old Afghan man when she was 17. Her husband sought asylum in the UK after 9/11, after which she joined him. “I suffer from constant depression,” she told us. “I am not allowed to go out without my husband’s permission. If I do, he doesn’t talk to me and throws food. He sometimes hits me. I have four kids. I am busy cooking and cleaning. Afghan culture is like that”.

Women we interviewed described issues of culture, religion and gender as key barriers to accessing sexual health services as well as public places in general. They expressed finding it difficult to be part of broader social life because they can’t engage with mainstream society – as if their lives were hermetically-sealed, guarded by virtual, community fences.

East London is home to many South Asian communities including members of the Afghan diaspora. Photo: Ritu Mahendru. These women also revealed that they don't associate sex with female pleasure – and that they often unwillingly bear the consequences of unprotected sex.

For Rabia, an inability to negotiate safe sex with her husband led to unintended pregnancies. She said: “Sometimes I don’t feel like having sex but he tells me that I am an educated woman and I should know that men have more sexual desires than women. Sometimes he doesn’t even care if the children are sleeping next to us”.

Knowledge of contraception is also shaped by myths and lack of trust in modern methods. One woman said pills are “not good for [one’s] health”. Another claimed: “I am breastfeeding and most pills aren't compatible”. A third woman said, similarly: “I do not want to take pills. I have heard that they have side effects”.

Many of the women we interviewed said it is ultimately their husband’s decision which form of contraception is used. Several said that Afghan men prefer ‘traditional’ methods to prevent pregnancies, specifically ‘early withdrawal.’ This is concerning as 1 in 4 women will get pregnant if ‘early withdrawal’ is the only form of contraception used.

“It’s my husband’s decision,” said one woman who told us her husband had insisted she use an IUD even though she hated it. Nasrin said, about her husband: “There is a whole bag of condoms in the cupboard. He has never used them”.

“There's a whole bag of condoms in the cupboard. He's never used them”

Each of the women we spoke to said that while they should have the right to accept sex, they may not have the right to dissent. From my experience over the last seven years, working with Afghan women in South Asia and in the UK, including as an activist and with NGOs, this is not uncommon: refusing to have sex and displeasing your husband could lead to violence, and in some cases it could be seen ‘un-Islamic’ too.

Some women said they had made joint decisions with their husbands to seek family planning advice. But even in these cases they said their GP appointments were almost always led by their husbands who acted as interpreters and had the final say.

One 34-year old woman, Samia*, complained of “a lack of interpretation services”. Nasrin said: “I know a lot of women… [for whom] their husbands do the translation. I am not sure if women are able to convey their sexual health problems to their GPs, out of fear, or out of being shy”.

All of the married women we interviewed complained that family planning programmes assumed that they were in charge, when in reality it is their husbands who govern their bodies and their choices.

‘The overall message is that no help is available’

The government’s integrated sexual health plan does not give any specific consideration to inequalities faced by minority women. Too much is left to the discretion of local NHS commissioners who are given no specific guidance on the needs of migrant women or how to monitor and address inequalities.

Rayah Feldman, at the charity Maternity Action, has also warned that women asylum-seekers and those with insecure immigration statuses are particularly impacted by ever-harsher discourse and legislation around their access to health care. Migrant women in the UK are currently required to pay 150% of routine tariffs for services if they haven't already paid a visa ‘health surcharge’.

South Asian clothes shop in London where Afghan women may buy traditional clothing. Photo: Ritu Mahendru.The women we spoke to emphasised that they are unable to even leave their homes to access basic health services without their husbands. This exclusion is amplified by the British government which emboldens a hyper-masculine religious agenda, and allows Sharia courts to run in the UK, while rebuking refugees from the Muslim world in the mainstream media. The overall message is that no help is available.

Health service professionals are failing to respond to minority women’s specialist needs. Rights to privacy and informed consent are being undermined by gender and racial stereotypes. Although sexual health or genitourinary medicine (GUM) clinics exist, they are not necessarily a one-stop shop for all services. Most of the women we interviewed did not know how to access them.

‘To empower women, sexual health programmes need to be integrated with other services’

London is also home, however, to positive models of secular organisation fighting racial and gender equality. I have been active for example with the group Southall Black Sisters that has defended Black and minority women from harsh judgments and racism from the outside while remaining critical of fundamentalism and sexism within their communities.

As human rights defenders and activists, we can learn from examples like this to help address the multi-layered challenges faced by Afghan immigrant women in London too. A key lesson is this: To empower women, sexual health programmes need to be integrated with other services. They must be linked to efforts challenging the lower status of women, as well as religious fundamentalism, in the Afghan diaspora.

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